Transgender Day of Remembrance is next week (Nov. 20, 2008). If you have never seen these sites: www.rememberingourdead.org and http://www.gpac.org/50under30/, you should check them out. Just be prepared for some really depressing stories. The sheer depth and breadth of human cruelty is always a surprise and a disappointment to me.
Coincidentally, this week I had a patient that really illustrates the importance of trans-friendly primary care. One of my patients, a transwoman, developed a serious skin infection. She had actually had the infection for a week, but had waited until her scheduled appointment with me to seek care for it. In fact, if she had not been scheduled to see me to discuss her hormones, I’m not sure she would have sought care until it was life-threatening. As it was, I had to bring in an attending physician to assess whether or not we could treat her as an outpatient or whether she needed to go to the ER for IV antibiotics. We decided to treat her as an outpatient (although we did check labs and blood cultures). I saw her again 3 days later to reassess her wound. It looked MUCH better. What had previously been a grapefruit-sized infection had shrunk to tennis-ball sized, the skin was not longer hot and red, and the patient was not longer nauseous and dizzy. She’s continuing her antibiotics and I’m going to see her next week.
So what were the beneficial outcomes here? To begin with, the patient felt comfortable enough to remove clothes to show me the area of infection, which led to her getting treatment before it spread to her bloodstream. Next, the patient was spared a visit to the emergency room (which can be a nightmare for gender-variant folks). Additionally, her insurance was spared the cost of the ER/hospital visit, which is a blessing in terms of keeping costs down. Lastly, her prompt treatment upon diagnosis spared her a surgical debriedment of the area, which is a painful, costly and resource-consuming treatment.
It not only behooves us as compassionate human beings to provider trans-accepting and trans-friendly health care, but it can also reduce ER visits, reduce costs and reduce morbidity. In your face, transphobic healthcare providers!